Health Care

How healthcare lost the nation’s trust, and how to bring it back

May 1, 2023  • Health, Medicine & Society Program

“Trust is built from a whole series of human interactions that have nothing to do with randomized controlled trials.”
— Dr. Richard Baron

People used to trust doctors. “We lined up to get our shots,” says Ruth Katz of the Institute’s Health, Medicine, and Society Program. “Our parents didn’t question what our doctors and the healthcare system said.” But things have changed, with trust in medicine dropping precipitously over the last 50 years, according to the Gallup trust barometer. That mistrust has a big effect on health outcomes for individuals and society.

To get to the roots of this mistrust—and to talk about ways the health care sector might begin repairing it—Katz sat down with Dr. Richard Baron, president and CEO of the American Board of Internal Medicine, and also a member of the Aspen Institute’s Health Strategy Group.

Physicians and the healthcare system “can’t just presume that we’re going to be trusted because we think we have good intentions and because we have great science,” says Baron. “We think that authority and legitimacy come from that expertise—that because we’re using rigorous scientific methods, we think a patient will trust us. But actually trust is built from a whole series of human interactions that have nothing to do with randomized controlled trials.”

Where mistrust comes from:

Attacks on expertise. Today, a claim of expertise is interpreted as arrogance, and many people think that science and medicine don’t put the interests of patients first. But some people have good reason to think this…

Health inequity. People of color can point to historical examples of poor treatment, of course, but current trends also show glaring disparities.

Quality and safety. There are challenges with quality and safety across the country, leaving patients unsure they can get through a surgery without something bad happening.

Affordability. Health care has become increasingly more expensive. “It’s not unreasonable for someone who’s filing a personal bankruptcy because of health care bills to say, ‘they’re not in this for me, they’re in this for them,’” says Baron.

What the healthcare system can do about it:

Technologically. “We’ve got teams focused on using technology to meet quality metrics or revenue cycle management or any number of things that people use technology for,” says Baron. What’s missing are simple things like noting how to pronounce patients’ names in the same files that keep track of their other vitals. “Patients want to be recognized. They want to be known. They want to feel like the people who are taking care of them know them.”

Institutionally. Hospitals can make a conscious choice to focus on improving trust. “All of us in our  institutions have management meetings. What are they talking about?,” asks Baron. “They’re talking about market share or bed occupancy or patient flow; could they devote one of those meetings to [how] to build trust with the people we serve?

Personally. “Fundamentally,” says Baron, “if everyone in health care sees every opportunity in which they’re interacting with a patient as an opportunity to either gain or lose trust, I think we would move very quickly in a direction of generating more trust.”

Watch the entire 17-minute conversation above.